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Declaratio~ ot Domicil• and Citizenship ~ ~
~ E
~
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FIORIDA: _
This is my decla~ation of Domicile and Citizenship in the Sta~~ of Florida that I am fili~g this day in aooordanos and
in oonformity with Chapter 22Z, Section 222.17, Florida Statutes.
Yunson 1[ass.
I was formerly a legal resident of
(City) ~ (State)
a~d I residad at ~ilbr8h&E ~o8d , Flowever I have chan~ed my domic3le
(Street and Number)
~
ro and am and have been a bona fide resident of the Stste of florida since 1st day of
J~ut~e ,~9~6
, and i~es;de a~ 105 Horth 37th etreet _
°(Street and Number)
fORT PIERCE, SAINT LUCIE COUNTY, RQRIDA
and this statement is to be taken as my declaration of citizenship, actual legal residenae and domicile in the State of Horida.
(Insert here any pertinent fads, such as sale of propery or busineu, or relinquishment of employi~.ent ~
at former domicile, remova) of family to new domicile, purchase of home, ete.)
Establishing residence FILEO AND RECORDED~
ST. ~UCIE COUNTY. FLA.
~F~p?~ ~IERI»tED
~88~'~'Z
~l~ JAH 29 PM 3: 12
t
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o~~~C'~,t.~
~ - Rl?i='tF? ;-V:TRt.S
' CLERiC CIRCUIT COUF,T~
I RJRTHER CfRTIFY that I will aomply with all other requiremenfs of a le~a) resident of thts State.
I FURTHER CERTIFY that I have no intention to retum to my former domicjle, and I intend to remain in FORT
PIE~~;~~~
~4})c1E eouNnr, FLORIDA, permanently.
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_ \ •`'•('~:i~_:'i .'A~~~.•, f /l
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' ~ a~~
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- ~ _ ~ " . : - , = patricia Connell ( lire Thomae
- _ - _ ;
=~a•. . ;~!;.;FC
'~'i; ~ • • - 'f' ~ \ (/~f~t@SS)
• S_•• "
Sworn to and subsuibed before me this ~9~ day of January ~ 19 70
ROGER POITRAS
CIRCUR COURT Notary Public •
B ~!'~'~`'~'G D.C. My Commission expires
(To b~ ~x~cut~d in duplicat~ and ori~inal Rl~d wh1~ qNlc Cirwit Courf, and duplicaN wilb Tax A~or.)
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